Coronary heart disease (CHD) is the leading cause of death, disability, and health care costs in the US. The majority of CHD patients continue to have acute cardiac events, many sudden and unexpected, despite identification and treatment of their disease and attention to the traditional risk factors. The pathophysiologic bases of these cardiac events are not fully established, but substantial evidence indicates that psychosocial stress and resulting sympathetic nervous system imbalance are major contributors. Evidence indicates that psychosocial stress and a hyperresponsive sympathetic nervous system have adverse effects on both vasomotor function and long-term autonomic balance. Recent advances in our understanding of the pathophysiology of acute cardiac events-specifically, identification of the roles that arterial vasomotor dysfunction and autonomic nervous system imbalances play in the interplay of psychosomatic stress and CHD. Preliminary evidence further suggests that Complementary and Alternative Medicine (CAM) practices, such as the Transcendental Meditation (TM) technique, can not only reduce stress but also reduce acute cardiac events in patients with CHD. Based on these and related data, we propose a randomized, blinded, controlled study of the effects of one CAM practice, the TM technique, compared to a control group, on the primary outcomes of (1) arterial vasomotor dysfunction (brachial artery reactivity); (2) autonomic nervous system imbalances (heart rate variability); (3) transient ambulatory myocardial ischemia (ST segment depression); and (4) the secondary outcomes of psychological stress and quality of life (anger, hostility, anxiety, depression, perceived health, disease-specific symptoms, and life stress/social resources). We hypothesize that significance effects on these physiological and psychological mechanisms associated with practice of the TM program will elucidate the known effectiveness of certain CAM techniques as additive/alternative approaches to prevention of acute cardiac events in CHD patients. Results of this randomized controlled trial will: (a) yield new data regarding the reversal of pathophysiological mechanisms underlying CHD, (b) provide mechanism data to complement our ongoing NIH- sponsored trial of this CAM practices on CVD-related mortality, and (c) provide pilot data for an expanded study of the effect of the TM technique on the pathophysiological mechanisms underlying acute cardiac events.